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Cognitive Therapy and Research

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15.10.2016 | Original Article

Psychophysiological Reactivity, Interoception and Emotion Regulation in Patients with Agoraphobia During Virtual Reality Anxiety Induction

verfasst von: Christoph Breuninger, David M. Sláma, Martina Krämer, Julian Schmitz, Brunna Tuschen-Caffier

Erschienen in: Cognitive Therapy and Research | Ausgabe 2/2017

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Abstract

The symptoms experienced by patients with agoraphobia are often attributed to excessive autonomic arousal, but recent theories postulate blunted rather than enhanced autonomic reactivity. Cognitive models explain this contrast by distorted interoception, possibly linked to dysfunctional emotion regulation under stress. In the current study, physiological measures were compared directly to their subjective perception in patients with agoraphobia (n = 21) and healthy controls (n = 27) in a virtual reality stressor. Blunted reactivity was confirmed for heart rate and parasympathetic influences on heart rate variability, but measures of sympathetic activation did not differ between groups. As expected, patients showed exaggerated perception of their physiological response. Usage of emotion regulation strategies during the stressor did not differ between groups, but patients reported strong difficulties in perception of and coping with emotions in a trait measure. Our findings suggest that distorted perception of physiological and emotional processes is central to agoraphobia.

Our study focus is agoraphobia, with special emphasis on the chronicity of anxiety that is not shared with panic disorder alone. Even though DSM-5 introduced agoraphobia as an independent diagnostic category, much relevant research has been conducted using the DSM-IV diagnosis of panic disorder with (or without) agoraphobia. We present such research where it is relevant to our study, using the authors’ original diagnostic terms (i.e. panic disorder).

Because time spent in the scenario and stressor conditions varied between participants, one to three minutes were used for psychophysiological analyses in each condition, depending on individual availability. Analyses did not change substantially when only using each participant’s first minute in these two conditions.

While the ratio of power in the low frequency band to that in the high frequency band was frequently reported as an indicator of cardiac SNS activity, such a connection has been refuted convincingly (Goedhart et al. 2008). Another measure of parasympathetic control of heart rate frequently reported in the literature, the time domain based square root of the mean squared differences of successive NN intervals (RMSSD) yielded results very similar to the HF-HRV we report.

All values were z-standardized, and the ibi values used as HR indicators were inverted so that higher values indicate faster heartbeat in accordance with the self-report measures.

All rs ≤ .25 with ps ≥ .2 for psychophysiological variables, using difference scores from baseline to stressor. All rs ≤ .35 with ps ≥ .08 for self-report variables. No correction for multiple testing applied.

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Titel: Psychophysiological Reactivity, Interoception and Emotion Regulation in Patients with Agoraphobia During Virtual Reality Anxiety Induction
verfasst von: Christoph Breuninger
David M. Sláma
Martina Krämer
Julian Schmitz
Brunna Tuschen-Caffier
Publikationsdatum: 15.10.2016
Verlag: Springer US
Erschienen in: Cognitive Therapy and Research / Ausgabe 2/2017
Print ISSN: 0147-5916
Elektronische ISSN: 1573-2819
DOI: https://doi.org/10.1007/s10608-016-9814-9

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Psychophysiological Reactivity, Interoception and Emotion Regulation in Patients with Agoraphobia During Virtual Reality Anxiety Induction

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